Clinical Profile and Outcomes of Pregnancy-Related Acute Kidney Injury in a Tertiary Care Centre: A Prospective Observational Study

Background: Pregnancy-related acute kidney injury (Pr-AKI) remains a major cause of maternal and fetal morbidity and mortality in developing countries, mostly due to sepsis, hypertensive disorders and obstetric hemorrhage. Aims and Objectives: To describe the clinical profile, etiology, severity and immediate maternal–fetal outcomes of Pr-AKI at a tertiary centre in Bundelkhand, central India. Materials and Methods: This prospective observational study enrolled 82 consecutive pregnant and postpartum women with Pr-AKI, diagnosed and staged by KDIGO serum creatinine criteria, at a tertiary centre in Jhansi (May 2025–April 2026). Categorical associations were tested with chi-square or Fisher's exact test and continuous variables with t-test or one-way ANOVA; all analyses were univariable (p<0.05 significant). Results: Mean age was 24.80 ± 4.48 years; 79.3% were multigravida and 57.3% unbooked. Onset was mainly postpartum (54.9%). Sepsis and preeclampsia were the commonest etiologies (23.2% each). KDIGO Stage 3 occurred in 40.2% and 50.0% required hemodialysis. At discharge, 47.6% had complete renal recovery, 34.1% partial recovery, 2.4% remained dialysis-dependent and 15.9% died. Live births occurred in 67.1% and stillbirths in 26.8%; fetal/perinatal mortality was 38.0% (30/79). Higher KDIGO stage was associated with dialysis (p<0.001), maternal death (p=0.020) and fetal/perinatal death (p<0.001). Vasopressor and mechanical ventilation requirements were strongly associated with maternal death (both p<0.001). Conclusion: Pr-AKI in this cohort was predominantly postpartum and severe, with maternal and fetal mortality rising steeply with KDIGO stage. Although unadjusted associations cannot establish causation, they support early recognition and prompt multidisciplinary management of sepsis, hypertensive disorders and hemorrhage in at-risk women.